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Comparison of successful outcome predictors for MicroPulse® laser trabeculoplasty and selective laser trabeculoplasty at 6 months

Authors Hirabayashi MT, Rosenlof TL, An JA

Received 21 February 2019

Accepted for publication 15 April 2019

Published 14 June 2019 Volume 2019:13 Pages 1001—1009

DOI https://doi.org/10.2147/OPTH.S205977

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Jie Zhang

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser


Video abstract presented by Dr Matthew T Hirabayashi.

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Matthew T Hirabayashi,1 Trevor L Rosenlof,1,2 Jella A An1,2

1University of Missouri Columbia School of Medicine, Columbia, MO, USA; 2Mason Eye Institute, Department of Ophthalmology, University of Missouri, Columbia, MO, USA

Purpose: To identify and compare factors predictive of successful outcome for MicroPulse® laser trabeculoplasty (MLT) and selective laser trabeculoplasty (SLT).
Methods: 50 MLT-treated eyes and 50 SLT-treated eyes of open-angle glaucoma patients were reviewed for baseline characteristics, pre- and postoperative IOP and medications, and adverse events including postoperative IOP elevation >5 mmHg (IOP spikes) through 6 months of follow-up. Success was defined as ≥20% IOP reduction or ≥1 medication reduction without additional IOP lowering procedures at 6 months follow-up.
Results: MLT and SLT had similar success rates (44% vs 40%, P=0.983). Older age predicted success for SLT (P=0.013) but not MLT (P=0.154). Both MLT and SLT led to greater IOP lowering in patients with baseline IOP >18 mmHg, but only for SLT did baseline IOP have a significant association with success (P=0.035 vs P=0.983). Number of laser shots was associated with success in MLT (P=0.031) but not in SLT (P=0.970). Glaucoma severity and pigmentation of the trabecular meshwork (PTM) were not associated with rate of success for either group. The rate of IOP spikes was significantly (P=0.022) higher in the SLT group (10%) compared to none in the MLT group. No other complications or visually significant adverse events occurred in either group.
Conclusion: Although MLT and SLT resulted in similar success rates, older age and higher baseline IOP predicted success for SLT while MLT was equally efficacious regardless of these factors. Glaucoma severity and PTM were not associated with success of either laser procedures. 10% of SLT patients experienced IOP spike post procedure, whereas none in the MLT group did. MLT may be a safer alternative to SLT that is effective in lowering IOP and need for medications for a wider variety of patients with open angle glaucoma.

Keywords: glaucoma, intraocular pressure, ocular hypertension, MLT, SLT, POAG

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